Re: My surgery consult results...

[Guest guest]

Hi ,

 

Sorry to hear all the troubles you are presently going thru and hope you and

your doctors can find a course of action that will help you for years to come.

 

I don't know if I am alone i saying this, but I am not at all thrilled with what

you are saying. Your esophagus (LES) is closed down so tightly that barium

cannot make it thru to your stomach, and the only way you can get food thru is

to " pile " it up so high (like a garbage dump), so you then have enough food

there to force it thru. If this is not a temporary (i.e. isolated event), you

really have a serious problem going on here.

 

While you have been correctly told some things about botox, you should also know

that some of us who have had it report that the " positive " effects of botox tend

to decline after each use (i.e. lasts shorter periods of time), and that the

surgery for some surgeons might become more difficult, though some surgeons

report that they can still manage thru the scar tissue, and this is besides what

your surgeon told you about perforations.

 

Just as an historical aside to what you said about 1993, laparascopic surgeries

were being done, and beyond the test phases, as early as 1991 in some

hospitals.  Mine was done open that year since the surgeon did not like closed

procedures (and to this day he still does them open), but the option existed 2

years before your surgery (water under the bridge now).  But, the main point in

saying that as it relates to a second myotomy for you is that you should seek

out more opinions. Surgeons are all full of opinions and if they feel

differently than someone else you have already spoken with they will tell you. 

Please don't be reluctant.  This is the quality of the rest of your life we are

talking about.

 

I am not sure about your commenting about eating softer foods without causing

more damage to your esophagus right now. What you said earlier in your message

was that food had to pile up to go thru. To me that means your LES is closed and

the walls of the esophagus are going to get stretched more.

I have no idea as to the progress of the stretching or your ability to eat from

now to graduation.

 

I truly admire your focus on achieving your degree without it being delayed by

the surgery. I also apologize if something I said might have upset you.

But, if we can't discuss, then it defeats the purpose of this support group.

 

If nothing else, please consider getting another opinion, for if it turns out

your plan is flawed and eating becomes impossible, graduation might have to

wait, since your health, both short term and long term, has to come first.

 

 

________________________________

From: heroldkelly <heroldkelly@...>

achalasia

Sent: Wednesday, March 14, 2012 8:46 AM

Subject: My surgery consult results...

 

So, I met with Dr. Kothari at Gundersen Lutheran on Monday, and we went

over my case. Basically my esophagus is closed completely at the very

bottom, and nothing goes through without being forced through. No barium

made it through to the stomach during my flouroscopy, and when I eat,

food sits in the esophagus until it piles up high enough in there to

reach the top 1/3-1/2 that still " swallows. " Then I can force it through

the muscle into the stomach at that point.

He gave me the option of trying botox, but warned that botox would be a

temporary fix (few months) and would have to continue to be repeated.

His concern with botox was that the more injections you receive, the

more chance of perforation when a myotomy would be done in the future,

and because my esophagus was stretched almost as large as my stomach, he

did not want to increase the chances of perforation anymore than need

be.

My other option, and the one we are taking, is to have a second myotomy

done. Because my first was in 1993, and done through the chest (before

laparoscopic was even available), he felt that he would be fine in doing

this one laparoscopically because the first myotomy would have been done

on the side of the esophagus where this would be on the front of it, so

less scar tissue to deal with.

Because I am able to force softer foods through without causing more

damage to the esophagus right now, we are able to wait until May 31 to

do the surgery since I am trying to finish my degree at this advanced

age of 37, and school ends before Memorial Day! So that makes me feel

better knowing I can finish the semester without trying to work and

study from a hospital bed or at home. Now, if anyone is bored and wants

to mow my lawn after I have surgery, I will let you!

Thanks, everyone for thoughts and prayers, and I hope you all are doing

well!

[Guest guest]

Hi

If the LES is closed try Magnesium Oxide, I buy it at 250 mg,

you can break it in half, maybe try four haves a day before meals.

It dissolves very easily with just a small amount of water, let it soak in the e

for awhile, and never comes up. Believe it sits in the E relaying it. You can

Google it as

or " magnesium oxide muscle relaxer "

or " magnesium oxide muscle relaxer pubmed "

You will find hundreds of articles on this.

http://www.cancer.gov/drugdictionary?cdrid=658594

If 500 mg may make the BM loose.I have been on it for years.

It is great for the heart, if you use a lot get a blood check. I use a total of

500 mg a day and a recent blood check was in the middle range.

PS I have had Achalasia 5+ years and no operations etc. Since I am retired it is

easy for me to experiment. If I was young like you and trying to earn a living

for my family, YES I would probally have an operation.

Once you have the operation , you still have to manage how to eat and what to

take to get food down. It is very important to clean out the e every night an

hour before bed time. This has been posted before.

Ray CA OC 81

I have posted this many times from a GERD report, it is worth

looking at.

Drugs Decrease LES Pressure

Anticholinergics

Barbiturates

Benzodiazepines

Calcium channel blockers

Caffeine

Dopamine

Estrogens

Nicotine

Opiates

Progesterone

Theophyllin

Foods Decrease LES Pressure

Chocolate

Coffee

Ethanol

Fat

Peppermint

Spearmint

High fiber diet

>

> So, I met with Dr. Kothari at Gundersen Lutheran on Monday, and we went

> over my case. Basically my esophagus is closed completely at the very

> bottom, and nothing goes through without being forced through. No barium

> made it through to the stomach during my flouroscopy, and when I eat,

> food sits in the esophagus until it piles up high enough in there to

> reach the top 1/3-1/2 that still " swallows. " Then I can force it through

> the muscle into the stomach at that point.

> He gave me the option of trying botox, but warned that botox would be a

> temporary fix (few months) and would have to continue to be repeated.

> His concern with botox was that the more injections you receive, the

> more chance of perforation when a myotomy would be done in the future,

> and because my esophagus was stretched almost as large as my stomach, he

> did not want to increase the chances of perforation anymore than need

> be.

> My other option, and the one we are taking, is to have a second myotomy

> done. Because my first was in 1993, and done through the chest (before

> laparoscopic was even available), he felt that he would be fine in doing

> this one laparoscopically because the first myotomy would have been done

> on the side of the esophagus where this would be on the front of it, so

> less scar tissue to deal with.

> Because I am able to force softer foods through without causing more

> damage to the esophagus right now, we are able to wait until May 31 to

> do the surgery since I am trying to finish my degree at this advanced

> age of 37, and school ends before Memorial Day! So that makes me feel

> better knowing I can finish the semester without trying to work and

> study from a hospital bed or at home. Now, if anyone is bored and wants

> to mow my lawn after I have surgery, I will let you!

> Thanks, everyone for thoughts and prayers, and I hope you all are doing

> well!

>

>

>

>

[Guest guest]

, sounds to me like the first Myotomy was a transthoracic -- they go in

from the left side, between ribs (collapse a lung?), and don't do a wrap

(because they're the chest cavity, not the abdominal cavity) -- a lap Heller

*wouldn't* run into any of the old scar tissue, and would be done in a different

place. A wrap might keep it from closing up again. Seems standard:

http://online.liebertpub.com/doi/abs/10.1089/109264203322656487

I absolutely agree about doing something temporary, whether it's botox, or

calcium channel blockers, or nitrates: *something* besides what's going on now.

And ~~ a Heller won't take you out for more than a week altogether (Lord

willing and the crick don't rise): NOT equivalent to the transthoracic op.

Easter vacation ought to do it. . . Just sayin' -- 'course, they won't let

you drive till you're done with pain meds. . . .

xox

>

> Hi ,

>  

> Sorry to hear all the troubles you are presently going thru and hope you and

your doctors can find a course of action that will help you for years to come.

>  

> I don't know if I am alone i saying this, but I am not at all thrilled with

what you are saying. Your esophagus (LES) is closed down so tightly that barium

cannot make it thru to your stomach, and the only way you can get food thru is

to " pile " it up so high (like a garbage dump), so you then have enough food

there to force it thru. If this is not a temporary (i.e. isolated event), you

really have a serious problem going on here.

>  

> While you have been correctly told some things about botox, you should also

know that some of us who have had it report that the " positive " effects of botox

tend to decline after each use (i.e. lasts shorter periods of time), and that

the surgery for some surgeons might become more difficult, though some surgeons

report that they can still manage thru the scar tissue, and this is besides what

your surgeon told you about perforations.

>  

> Just as an historical aside to what you said about 1993, laparascopic

surgeries were being done, and beyond the test phases, as early as 1991 in some

hospitals.  Mine was done open that year since the surgeon did not like closed

procedures (and to this day he still does them open), but the option existed 2

years before your surgery (water under the bridge now).  But, the main point in

saying that as it relates to a second myotomy for you is that you should seek

out more opinions. Surgeons are all full of opinions and if they feel

differently than someone else you have already spoken with they will tell you. 

Please don't be reluctant.  This is the quality of the rest of your life we are

talking about.

>  

> I am not sure about your commenting about eating softer foods without causing

more damage to your esophagus right now. What you said earlier in your message

was that food had to pile up to go thru. To me that means your LES is closed and

the walls of the esophagus are going to get stretched more.

> I have no idea as to the progress of the stretching or your ability to eat

from now to graduation.

>  

> I truly admire your focus on achieving your degree without it being delayed by

the surgery. I also apologize if something I said might have upset you.

> But, if we can't discuss, then it defeats the purpose of this support group.

>  

> If nothing else, please consider getting another opinion, for if it turns out

your plan is flawed and eating becomes impossible, graduation might have to

wait, since your health, both short term and long term, has to come first.

>  

>

>  

>

>

> ________________________________

> From: heroldkelly <heroldkelly@...>

> achalasia

> Sent: Wednesday, March 14, 2012 8:46 AM

> Subject: My surgery consult results...

>

>

>  

> So, I met with Dr. Kothari at Gundersen Lutheran on Monday, and we went

> over my case. Basically my esophagus is closed completely at the very

> bottom, and nothing goes through without being forced through. No barium

> made it through to the stomach during my flouroscopy, and when I eat,

> food sits in the esophagus until it piles up high enough in there to

> reach the top 1/3-1/2 that still " swallows. " Then I can force it through

> the muscle into the stomach at that point.

> He gave me the option of trying botox, but warned that botox would be a

> temporary fix (few months) and would have to continue to be repeated.

> His concern with botox was that the more injections you receive, the

> more chance of perforation when a myotomy would be done in the future,

> and because my esophagus was stretched almost as large as my stomach, he

> did not want to increase the chances of perforation anymore than need

> be.

> My other option, and the one we are taking, is to have a second myotomy

> done. Because my first was in 1993, and done through the chest (before

> laparoscopic was even available), he felt that he would be fine in doing

> this one laparoscopically because the first myotomy would have been done

> on the side of the esophagus where this would be on the front of it, so

> less scar tissue to deal with.

> Because I am able to force softer foods through without causing more

> damage to the esophagus right now, we are able to wait until May 31 to

> do the surgery since I am trying to finish my degree at this advanced

> age of 37, and school ends before Memorial Day! So that makes me feel

> better knowing I can finish the semester without trying to work and

> study from a hospital bed or at home. Now, if anyone is bored and wants

> to mow my lawn after I have surgery, I will let you!

> Thanks, everyone for thoughts and prayers, and I hope you all are doing

> well!

>

>

>

[Guest guest]

Hi ,

 

As far as I know you are correct about it sounding like a transthoracic

operation.  But having one myself in 1991 (going in on the left side and

collapsing the lung), I did have a wrap done, so the same might apply to .

  As for the rest, I hope the surgery can help her.

 

Since the surgery won't be performed for a couple of months, I share your

opinion that perhaps the best way to assist her in making it from now until then

would be by botox. A calcium channel blocker (such as nifedipine) should be

tried first if she can tolerate it, being less severe than a botox injection.

 

I hope all goes well.

 

________________________________

From: puddleriver13 <puddleriver13@...>

achalasia

Sent: Wednesday, March 14, 2012 6:48 PM

Subject: Re: My surgery consult results...

 

, sounds to me like the first Myotomy was a transthoracic -- they go in

from the left side, between ribs (collapse a lung?), and don't do a wrap

(because they're the chest cavity, not the abdominal cavity) -- a lap Heller

*wouldn't* run into any of the old scar tissue, and would be done in a different

place. A wrap might keep it from closing up again. Seems standard:

http://online.liebertpub.com/doi/abs/10.1089/109264203322656487

I absolutely agree about doing something temporary, whether it's botox, or

calcium channel blockers, or nitrates: *something* besides what's going on now.

And ~~ a Heller won't take you out for more than a week altogether (Lord

willing and the crick don't rise): NOT equivalent to the transthoracic op.

Easter vacation ought to do it. . . Just sayin' -- 'course, they won't let you

drive till you're done with pain meds. . . .

xox

>

> Hi ,

>  

> Sorry to hear all the troubles you are presently going thru and hope you and

your doctors can find a course of action that will help you for years to come.

>  

> I don't know if I am alone i saying this, but I am not at all thrilled with

what you are saying. Your esophagus (LES) is closed down so tightly that barium

cannot make it thru to your stomach, and the only way you can get food thru is

to " pile " it up so high (like a garbage dump), so you then have enough food

there to force it thru. If this is not a temporary (i.e. isolated event), you

really have a serious problem going on here.

>  

> While you have been correctly told some things about botox, you should also

know that some of us who have had it report that the " positive " effects of botox

tend to decline after each use (i.e. lasts shorter periods of time), and that

the surgery for some surgeons might become more difficult, though some surgeons

report that they can still manage thru the scar tissue, and this is besides what

your surgeon told you about perforations.

>  

> Just as an historical aside to what you said about 1993, laparascopic

surgeries were being done, and beyond the test phases, as early as 1991 in some

hospitals.  Mine was done open that year since the surgeon did not like

closed procedures (and to this day he still does them open), but the option

existed 2 years before your surgery (water under the bridge now).  But, the

main point in saying that as it relates to a second myotomy for you is that

you should seek out more opinions. Surgeons are all full of opinions and if they

feel differently than someone else you have already spoken with they will tell

you.  Please don't be reluctant.  This is the quality of the rest of your

life we are talking about.

>  

> I am not sure about your commenting about eating softer foods without causing

more damage to your esophagus right now. What you said earlier in your message

was that food had to pile up to go thru. To me that means your LES is closed and

the walls of the esophagus are going to get stretched more.

> I have no idea as to the progress of the stretching or your ability to eat

from now to graduation.

>  

> I truly admire your focus on achieving your degree without it being delayed by

the surgery. I also apologize if something I said might have upset you.

> But, if we can't discuss, then it defeats the purpose of this support group.

>  

> If nothing else, please consider getting another opinion, for if it turns out

your plan is flawed and eating becomes impossible, graduation might have to

wait, since your health, both short term and long term, has to come first.

>  

>

>  

>

>

> ________________________________

> From: heroldkelly <heroldkelly@...>

> achalasia

> Sent: Wednesday, March 14, 2012 8:46 AM

> Subject: My surgery consult results...

>

>

>  

> So, I met with Dr. Kothari at Gundersen Lutheran on Monday, and we went

> over my case. Basically my esophagus is closed completely at the very

> bottom, and nothing goes through without being forced through. No barium

> made it through to the stomach during my flouroscopy, and when I eat,

> food sits in the esophagus until it piles up high enough in there to

> reach the top 1/3-1/2 that still " swallows. " Then I can force it through

> the muscle into the stomach at that point.

> He gave me the option of trying botox, but warned that botox would be a

> temporary fix (few months) and would have to continue to be repeated.

> His concern with botox was that the more injections you receive, the

> more chance of perforation when a myotomy would be done in the future,

> and because my esophagus was stretched almost as large as my stomach, he

> did not want to increase the chances of perforation anymore than need

> be.

> My other option, and the one we are taking, is to have a second myotomy

> done. Because my first was in 1993, and done through the chest (before

> laparoscopic was even available), he felt that he would be fine in doing

> this one laparoscopically because the first myotomy would have been done

> on the side of the esophagus where this would be on the front of it, so

> less scar tissue to deal with.

> Because I am able to force softer foods through without causing more

> damage to the esophagus right now, we are able to wait until May 31 to

> do the surgery since I am trying to finish my degree at this advanced

> age of 37, and school ends before Memorial Day! So that makes me feel

> better knowing I can finish the semester without trying to work and

> study from a hospital bed or at home. Now, if anyone is bored and wants

> to mow my lawn after I have surgery, I will let you!

> Thanks, everyone for thoughts and prayers, and I hope you all are doing

> well!

>

>

>

[Guest guest]

, sorry about trying to teach you to suck eggs, lol! Have to say,

though, that you're the first transthoracic wrap I've heard of. Seems like

usually the trans guys claim you don't need a wrap 'cause they can cut longer. .

.. . And I don't get how they *can* do a wrap -- pull the stomach up into the

chest cavity? Ouchie!

Had to go back and check: I'd assumed was a guy 'cause the only I

know *is* a guy, lol! He is: vide his " My poor wife " post. . .

xox

> >

> > Hi ,

> >  

> > Sorry to hear all the troubles you are presently going thru and hope you and

your doctors can find a course of action that will help you for years to come.

> >  

> > I don't know if I am alone i saying this, but I am not at all thrilled with

what you are saying. Your esophagus (LES) is closed down so tightly that barium

cannot make it thru to your stomach, and the only way you can get food thru is

to " pile " it up so high (like a garbage dump), so you then have enough food

there to force it thru. If this is not a temporary (i.e. isolated event), you

really have a serious problem going on here.

> >  

> > While you have been correctly told some things about botox, you should also

know that some of us who have had it report that the " positive " effects of botox

tend to decline after each use (i.e. lasts shorter periods of time), and that

the surgery for some surgeons might become more difficult, though some surgeons

report that they can still manage thru the scar tissue, and this is besides what

your surgeon told you about perforations.

> >  

> > Just as an historical aside to what you said about 1993, laparascopic

surgeries were being done, and beyond the test phases, as early as 1991 in some

hospitals.  Mine was done open that year since the surgeon did not like

closed procedures (and to this day he still does them open), but the option

existed 2 years before your surgery (water under the bridge now).  But, the

main point in saying that as it relates to a second myotomy for you is that

you should seek out more opinions. Surgeons are all full of opinions and if they

feel differently than someone else you have already spoken with they will tell

you.  Please don't be reluctant.  This is the quality of the rest of your

life we are talking about.

> >  

> > I am not sure about your commenting about eating softer foods without

causing more damage to your esophagus right now. What you said earlier in your

message was that food had to pile up to go thru. To me that means your LES is

closed and the walls of the esophagus are going to get stretched more.

> > I have no idea as to the progress of the stretching or your ability to eat

from now to graduation.

> >  

> > I truly admire your focus on achieving your degree without it being delayed

by the surgery. I also apologize if something I said might have upset you.

> > But, if we can't discuss, then it defeats the purpose of this support group.

> >  

> > If nothing else, please consider getting another opinion, for if it turns

out your plan is flawed and eating becomes impossible, graduation might have to

wait, since your health, both short term and long term, has to come first.

> >  

> >

> >  

> >

> >

> > ________________________________

> > From: heroldkelly <heroldkelly@>

> > achalasia

> > Sent: Wednesday, March 14, 2012 8:46 AM

> > Subject: My surgery consult results...

> >

> >

> >  

> > So, I met with Dr. Kothari at Gundersen Lutheran on Monday, and we went

> > over my case. Basically my esophagus is closed completely at the very

> > bottom, and nothing goes through without being forced through. No barium

> > made it through to the stomach during my flouroscopy, and when I eat,

> > food sits in the esophagus until it piles up high enough in there to

> > reach the top 1/3-1/2 that still " swallows. " Then I can force it through

> > the muscle into the stomach at that point.

> > He gave me the option of trying botox, but warned that botox would be a

> > temporary fix (few months) and would have to continue to be repeated.

> > His concern with botox was that the more injections you receive, the

> > more chance of perforation when a myotomy would be done in the future,

> > and because my esophagus was stretched almost as large as my stomach, he

> > did not want to increase the chances of perforation anymore than need

> > be.

> > My other option, and the one we are taking, is to have a second myotomy

> > done. Because my first was in 1993, and done through the chest (before

> > laparoscopic was even available), he felt that he would be fine in doing

> > this one laparoscopically because the first myotomy would have been done

> > on the side of the esophagus where this would be on the front of it, so

> > less scar tissue to deal with.

> > Because I am able to force softer foods through without causing more

> > damage to the esophagus right now, we are able to wait until May 31 to

> > do the surgery since I am trying to finish my degree at this advanced

> > age of 37, and school ends before Memorial Day! So that makes me feel

> > better knowing I can finish the semester without trying to work and

> > study from a hospital bed or at home. Now, if anyone is bored and wants

> > to mow my lawn after I have surgery, I will let you!

> > Thanks, everyone for thoughts and prayers, and I hope you all are doing

> > well!

> >

> >

> >

[Guest guest]

Yep! I'm a guy! I understand 's initial concerns, but there is a lot of

info you guys don't have about this, so I always remind myself that if we were

able to share all of our medical history and carts and tests, we would be better

with understanding each other's issues, but we don't have that much time on our

hands! Yeah, I completely trust the doctor and trust that he has helped us

reach the correct decision. Part of this is that a friend my wife has known

since the first grade is a surgical resident in the hospital that I will be

having surgery at. She told me that this surgeon has already done five second

myotomies this year and that he is the best surgeon she has ever met or worked

with. Obviously practice doesn't make " perfect " but it does help! As far as the

first myotomy goes, Mine was done at the Mayo Clinic in Rochester, MN, by Dr.

Tratek, who was considered in the top five in his field at the time I had the

surgery done. I had wonderful results from that surgery, and it lasted me almost

20 years, so I have no problems with trying another one now that the remainder

of my LES is being a stinker. Again, each person has their own issues that go

along with this disease, and one of mine has been that my body heals extremely

fast and that has caused such things as dilitations and the like to utterly fail

in the past. My doctor has assured me that if I have any issues at all, or even

just change my mind, he will get me in ASAP, and I believe he will do just

great! It is kind of fun to see what happens when all the opinions fly on here!

I had to laugh when my doctor told the resident that was helping him out that

I should have told her all about achalasia since I knew all the things he was

telling me before he said them. I told him that after 20 years of living with

anything, you kind of become an " expert " by default!

[Guest guest]

People think I am a 'guy' with a name like !! LOL

>

>

> Yep! I'm a guy! I understand 's initial concerns, but there is a lot of

info you guys don't have about this, so I always remind myself that if we were

able to share all of our medical history and carts and tests, we would be better

with understanding each other's issues, but we don't have that much time on our

hands! Yeah, I completely trust the doctor and trust that he has helped us

reach the correct decision. Part of this is that a friend my wife has known

since the first grade is a surgical resident in the hospital that I will be

having surgery at. She told me that this surgeon has already done five second

myotomies this year and that he is the best surgeon she has ever met or worked

with. Obviously practice doesn't make " perfect " but it does help! As far as the

first myotomy goes, Mine was done at the Mayo Clinic in Rochester, MN, by Dr.

Tratek, who was considered in the top five in his field at the time I had the

surgery done. I had wonderful results from that surgery, and it lasted me almost

20 years, so I have no problems with trying another one now that the remainder

of my LES is being a stinker. Again, each person has their own issues that go

along with this disease, and one of mine has been that my body heals extremely

fast and that has caused such things as dilitations and the like to utterly fail

in the past. My doctor has assured me that if I have any issues at all, or even

just change my mind, he will get me in ASAP, and I believe he will do just

great! It is kind of fun to see what happens when all the opinions fly on here!

I had to laugh when my doctor told the resident that was helping him out that

I should have told her all about achalasia since I knew all the things he was

telling me before he said them. I told him that after 20 years of living with

anything, you kind of become an " expert " by default!

>

>

>

>

>

>

>

[Guest guest]

wrote:

>

> ... Because I am able to force softer foods through without causing more

> damage to the esophagus right now, we are able to wait until May 31 to

> do the surgery ... .

>

Seems reasonable to me. You have gone 20 years whats a few month. It

sometimes takes that long just to get through all the test and book a

surgery.

notan